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EXAMINATION METHODS EXAMINATION METHODS The main subjective patient interview objective methods exam palpation percussion and auscultation Additional methods laboratory instrumental Palpation palpation Palpation palpation Clinical method of examination in order to detect physical symptoms of a disease by palpation of organs and tissues The general rules of palpation hands should be warm fingernails trimmed short standing lying down Palpation Superficial Deep sliding thrusting penetrating Superficial palpation Skin temperature turgor swelling moisture soreness Lymph nodes which groups are palpated number size consistency tenderness adhesiveness Chest over lungs painfulness determination of vocal trembling pleural friction noise Cardiovascular system Pulse symmetry frequency rhythm filling tension magnitude Determination of the apical thrust determination of the cardiac thrust Cat purr symptom definition Pericardial friction sound definition Thyroid gland Bones muscles joints Abdominal wall soreness muscle tension tumors peristalsis Palpation of the skin determine the pulse Determine the pulse on both hands at the same time Determine the pulse on one arm determine the pulse in the carotid determine the pulse on the artery temporal artery determine the pulse on the leg Palpation of lymph nodes When palpating submandibular lymph nodes they are pressed against the lower jaw Cervical lymph nodes are palpated along the anterior and posterior edges of the sternocleidomastoid muscle Supraclavicular lymph nodes are palpated above the clavicle subclavicular lymph nodes under it When palpating axillary lymph nodes the patient should put his hands to his sides Thyroid palpation the patient s head is tilted slightly forward the examiner places 4 fingers of both hands deep behind the posterior edges of the sternocleidomastoid muscles and the thumbs on the anterior surface of the neck Thyroid palpation First palpate the isthmus on the anterior surface of the neck Thyroid palpation Then we palpate its lobes on the anterolateral surfaces in front of the sternocleidomastoid muscles Determination of the apex beat 1 put the palm of your right hand on the subject s chest with the base of the hand to the sternum and with fingers to the axillary area between 3 4 ribs 2 use the pulp of the end phalanges of 3 bent fingers to specify the place of the thrust Palpation of the chest Chest pain is determined by palpation of the patient s ribs and intercostals with the pads of 2 3 fingers of the physician s hands Palpation reveals areas of soreness in the thorax ribs and sternum Voice tremor Determining the elasticity of the thorax Determining voice tremor Constitutional types by Chornoruzkiy It is determined due to the size of costal arcs angle of a person Normosthenic 90 degree Hypersthenic more than 90 degree Asthenic less than 90 degree Superficial palpation of the abdomen Superficial palpation of the abdomen During superficial palpation the examiner places his right hand with slightly bent fingers on the patient s abdomen and gently without penetrating deeply begins palpating all parts of the abdomen clockwise and then along the white line of the abdomen Deep sliding palpation The examiner s fingers penetrate deep into the abdominal cavity and receive a tactile sense of the organ being palpated as it slides off Deep palpation sigmoid colon Rectum Ascending colon descending colon transverse colon Stomach liver Gallbladder pancreas Spleen Kidneys Palpation of the liver Palpation of the liver is performed using the method of deep methodical palpation according to the Obraztsov Strazhesko method The doctor sits on the right side of the patient and places the palm of the right hand on the anterior abdominal wall in the area of the right subcostal area with the left hand squeezing the rib arch to limit respiratory excursions of the liver According to V P Obraztsov normal liver is palpated in 88 of cases Palpatory sensations received from the lower edge of the liver allow determining its physical properties soft dense uneven sharp rounded sensitive etc Palpation of the spleen Palpation of the spleen is done while the patient is lying on his back or on the right side In this position the abdominal press is maximally relaxed and the spleen is closer to the front The doctor places his left hand on the left side of the patient s chest between VII and X ribs along the axillary lines and squeezes it slightly limiting its movements while breathing Normally the spleen is not palpable It becomes palpable only with significant prolapse The kidneys are not normally palpated Palpation of the sigmoid colon Palpation in the left ileum with 4 slightly bent fingers of the right hand folded together Palpation of the cecum Palpated in the right iliac region Palpation of the ascending and descending colon The ascending part is a continuation of the cecum and the descending part goes into the sigmoid colon Palpation of the transverse colon Palpated with two hands on either side of the midline of the abdomen after determining the lower border of the large curvature of the stomach Percussion A clinical method of examination by tapping to determine the physical properties of the organs and the topographic relationship between them TOPOGRAPHIC PERCUSSION Lungs Heart Liver Spleen COMPARATIVE PERCUSSION Lungs Kidneys Control questions Examination of the chest of a healthy patient Form of the thorax normosthenic hypersthenic asthenic Palpation of the chest Palpation of the heart area Examination of the peripheral arteries properties Types of breathing thoracic abdominal mixed of the pulse their diagnostic criteria Examination of the oral cavity Examination of the abdomen Body build Concept of constitutional type Palpation of the organs of a healthy person The significance of the method Palpation of lymph nodes Palpation of the thyroid gland Palpation of the joints Oriented superficial palpation technique Deep methodical sliding palpation according to the method of V P Obraztsov N D Strazhesko Palpation of the abdominal organs stomach parts of the intestine Palpation of the abdominal cavity liver spleen Palpation of the kidneys Control questions Percussion as a method of research biophysical basis of Projection of the different parts of the heart on the front percussion General rules and technique of percussion The main percussion sounds in the norm Comparative percussion of the lungs technique Topographic percussion of the lungs

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